Cervical or intrathoracic: JAMA study finds optimal location for esophagogastric anastomosis for esophagectomy

Patients were randomly assigned (1:1) to transthoracic MIE with intrathoracic or cervical anastomosis. The primary end point was anastomotic leakage requiring endoscopic, radiologic, or surgical intervention. Secondary outcomes were overall anastomotic leak rate, other postoperative complications, length of stay, mortality, and quality of life.

Data analysis revealed some interesting facts.

• Two hundred sixty-two patients were randomized, and 245 were eligible for analysis. Anastomotic leakage necessitating reintervention occurred in 15 of 122 patients with intrathoracic anastomosis (12.3%) and in 39 of 123 patients with cervical anastomosis (31.7%; risk difference, −19.4% [95% CI, −29.5% to −9.3%]).
• Overall anastomotic leak rate was 12.3% in the intrathoracic anastomosis group and 34.1% in the cervical anastomosis group (risk difference, −21.9% [95% CI, −32.1% to −11.6%]).
• Intensive care unit length of stay, mortality rates, and overall quality of life were comparable between groups, but intrathoracic anastomosis was associated with fewer severe complications (risk difference, −11.3% [−20.4% to −2.2%]), lower incidence of recurrent laryngeal nerve palsy (risk difference, −7.3% [95% CI, −12.1% to −2.5%]), and better quality of life in 3 subdomains (mean differences: dysphagia, −12.2 [95% CI, −19.6 to −4.7]; problems of choking when swallowing, −10.3 [95% CI, −16.4 to 4.2]; trouble with talking, −15.3 [95% CI, −22.9 to −7.7]).

"Future research will be needed to evaluate to what extent broad implementation of transthoracic MIE with intrathoracic anastomosis will lead to improved patient outcomes and assess long-term functional and oncological outcome between patients with intrathoracic and cervical anastomosis after transthoracic MIE."the team concluded.

For full article follow the link: 10.1001/jamasurg.2021.1555

Primary source: JAMA Surgery